Fill and Sign the 5 B C Form

F.C.A. §§ 433, 453, 454, ART.5-B; C.P.L.R § 5242 Form 4-12a-1(Violation of Support Order) 8/2010FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF In the Matter of a Proceeding for Support underArticle of the Family Court ActDocket No.(Commissioner of Social Services, Assigneeon behalf of , Assignor)SUMMONSPetitioner, (Violation of Support Order) -against-Respondent. NOTICE: YOUR FAILURE TO APPEAR IN COURT MAY RESULT IN YOURIMMEDIATE ARREST. YOUR FAILURE TO APPEAR MAY RESULT INSUSPENSION OF YOUR DRIVER’S LICENSE, STATE-ISSUED PROFESSIONAL,OCCUPATIONAL AND BUSINESS LICENSES; AND RECREATIONAL ANDSPORTING LICENSES AND PERMITS. YOU HAVE THE RIGHT TO BEREPRESENTED BY A LAWYER. IF YOU CANNOT AFFORD A PRIVATE LAWYER,YOU HAVE THE RIGHT TO ASK THE COURT TO ASSIGN A LAWYER. IF, AFTERHEARING, THE JUDGE FINDS THAT YOU WILLFULLY FAILED TO OBEY THEORDER, YOU MAY BE IMPRISONED FOR A TERM NOT TO EXCEED SIXMONTHS FOR CONTEMPT OF COURT. IN THE NAME OF THE PEOPLE OF THE STATE OF NEW YORK TO THE ABOVE-NAMED RESPONDENT: who resides or is found at A petition having been filed alleging that you have failed to obey the support orderdated , made by this Court under Article of the Family Court Act, a copy of thepetition being annexed hereto;YOU ARE HEREBY SUMMONED to appear before this Court at , New York on , , at o’clock in the noon of that day toanswer the petition and show cause why you should not be dealt with in accordance with Section454 of the Family Court Act and Section 5242 of the Civil Practice Law and Rules. Form 4-12-a-1 page 2Dated: , .BY ORDER OF THE COURT Clerk of the CourtNOTICE: Pursuant to Section 433 of the Family Court Act, you may qualify to testify bytelephone, audio-visual means or other electronic means if you reside in a county in New YorkState not contiguous to the Family Court in which the matter will be heard, if you areincarcerated and do not expect to be released within a reasonable period of time after thescheduled date or if you will suffer an undue hardship by appearing in court. The five counties ofNew York City are treated as one county for purposes of this section. If you wish to requestpermission, you must submit Form 4-24/5-16/UIFSA-10, which you may obtain from FamilyCourt or on the internet at www.nycourts.gov.NOTICE: Family Court Act §154(c) provides that petitions brought pursuant to Articles 4, 5, 6,8 and 10 of the Family Court Act, in which an order of protection is sought or in which aviolation of an order of protection is alleged, may be served outside the State of New York upona Respondent who is not a resident or domiciliary of the State of New York. If no other groundsfor obtaining personal jurisdiction over the Respondent exist aside from the application of thisprovision, the exercise of personal jurisdiction over the Respondent is limited to the issue of therequest for, or alleged violation of, the order of protection. Where the Respondent has beenserved with this summons and petition and does not appear, the Family Court may proceed to ahearing with respect to issuance or enforcement of the order of protection.